Journal of Military Learning

The Effects of Combat Stress on Women in a Military Academic EnvironmentPeer-Review

Col. Paul E. Berg, PhD, U.S. Army

Jessica Rousseau, MS

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Abstract

This research describes how combat experiences affected female Army officers who attended the Command and General Staff Officer College (CGSOC) in Fort Leavenworth, Kansas. The female Army officers’ combat experiences were found to affect their academic learning, classroom experience, and coping mechanisms in a graduate-level professional military education. The themes identified included combat-related gender specific experiences and additional gender themes related to learning in a male-dominated military education environment. Nine female active duty Army officers participated in this research, with each having a minimum of two combat tours. In addition, two active duty Army CGSOC military instructors and two behavioral counselors specializing in military patients were also interviewed.

The findings of this case study indicated that combat experiences affect female students who served in the Army in Iraq and Afghanistan. This study contributes the continued research on effects of combat on adult learning, specifically adding to the limited works on being a female serving in the Army.

 

The terrorist attacks of 9/11 in New York City and the Pentagon resulted in the cumulative deployment of over 2.5 million American military troops in the last fifteen years to Afghanistan as part of Operation Enduring Freedom (OEF), and Iraq in support of Operation Iraqi Freedom (OIF) and Operation New Dawn (OND), which is unprecedented in the history of an all-volunteer American force.1 As of January 2018, more than 2,350 U.S. troops had been killed in Afghanistan, and 4,424 troops had been killed in Iraq, with over 52,644 troops returning from combat zones with visible wounds.2 The United States military was required to support multiple back-to-back combat tours; between deployments, troops had minimal time at home due to increased training requirements in preparation for upcoming combat tours. This frenzied pace reduced time at home with soldiers’ families, resulting in an accumulation of combat stress on military troops in support of two global military campaigns.3

Although both full-combat military campaigns have concluded—Iraq in 2012 and Afghanistan in 2015—the resulting effects of combat on soldiers are still not fully understood. The consequences of combat experiences will continue to impact soldiers, both while they are in the military and well into their civilian lives.4 Recent combat stress research has indicated that women have an increased risk of interpersonal stressors, while adjustments of postdeployment assimilation of female veterans are comparable to male veterans.5

Background

War has always been a part of our human civilization, and it has resulted in burdening soldiers through its inherent psychological effects. Throughout our U.S. military history, there has been evidence of the effects of war on soldiers’ psyche, and efforts to protect soldiers from it have been an important, enduring struggle.6

Since 9/11 and the beginning of the Global War on Terrorism, over 150,000 female soldiers have served in combat, 147 women have been killed, and 619 women have been wounded in combat during OIF/OEF/OND deployments.7 Thousands of women have combat-related experiences and combat trauma resulting from exposure to combat-related violence, sexual trauma, and other combat- and gender-related stress during their deployments.8 Since 2011, the number of veterans diagnosed with combat-related trauma conditions has almost doubled nationally, but this number does not reflect the total number affected, as many veterans have not been diagnosed.9 Additionally, women have been found to experience significantly higher rates of sexual harassment and assault than men, both within and outside the military.10 This, in turn, has contributed to their higher rates of posttraumatic stress disorder (PTSD). Also, female veterans experience higher rates of major depression and generalized anxiety than do male veterans.11

The U.S. Army’s Command and General Staff School (CGSS) facilitates the Command the General Staff Officer’s Course (CGSOC) at Fort Leavenworth, Kansas, which is the Department of Army’s resident course for senior captains and junior majors with an average of nine to twelve years of military service.12 Officers chosen to attend complete their Intermediate Level Education (ILE) requirement for professional military education (PME).13 This PME is also a requirement for Army majors to be eligible for promotion to the next rank of lieutenant colonel.

In the spring of 2015, the Department of Army ILE selection board selected 1,104 CGSOC resident students to attend the resident course who had also recently been selected to the rank of major (see table 1). The selection rate for the residential CGSOC course at Fort Leavenworth was 55 percent (of applicants) for the academic class of 2015.14 The combat demographics of the class include 81 percent (850/1104 students) who served in combat, 44 percent (377/1104 students) who served in two combat tours, and 36 percent (360/1104 students) who served in three or more tours.15 Of the 1,104 students in the CGSOC class of 2015, 132 students were from the U.S. Navy, Marine Corps, and Air Force, and 16 students were from the Department of Homeland Security, Department of State, and other civilian government agencies. Women represented 14 percent (155/1104 students) of the 2015 CGSOC student population with one to two female students in each classroom.16

Research Question

How do female CGSS students perceive how their multiple combat experiences affect their learning experiences?

Methodology

This research used a qualitative case study methodology. Female students were purposely selected from the 2015 CGSOC class for the research, which provided them an avenue to describe their combat and learning experiences. Initially, the female student population selected came from the 155 total female students who enrolled in CGSOC. Subsequent screening reduced the number to 109 active-duty Army female students and the additional screening criteria of two combat tours reduced the number to 79 female students. Of the 79 female students available, nine female Army students (11 percent) volunteered to be interviewed for this study. Semistructured interviews with open-ended questions were used to document personal narration within the research methodology. The sample for this study included women of various ethnicities and minority groups. Two CGSOC female faculty members and two behavioral health counselors were also interviewed as a part of this research. Analysis of data in this research was peer reviewed and also reviewed by several CGSOC faculty members who have doctoral degrees in adult education.

Table 1. Start Data: 2015 (Table from Command Brief, U.S. Army Combined Arms Center, 2015)

Significance of the Study

Understanding the effects of combat-related stress on women’s learning in a military academic environment is significant in providing information to Command and General Staff College (CGSC) leadership, Army University, the U.S. Army Combined Arms Center, and the Department of the Army.17 Additional research that contributes to gender studies and women’s experiences in a military educational environment will assist the Army in understanding how to improve women’s educational experiences within the Army. Due to the changes of military assignment policy in 2015, this study on females’ lived experiences is critically important to conducting research on the effects of combat on women, primarily because of the profound effect this study could have on future leadership opportunities for women in the Army.18

This research was the first exploratory case study conducted at CGSS focusing on understanding the effects of combat on female students in a military academic environment. This research captured narrative and descriptive comments that represent the volunteered voices of these two-time combat veteran, female students serving in the U.S. Army and attending the ten-month resident CGSOC at Fort Leavenworth.

Sample

The student sample for this research was drawn from female Army majors within the CGSOC class of 2015 population. The student female sample was purposefully selected from 155 CGSOC female students. The first requirement for the sample was to screen female U.S. Army majors to exclude Navy, Marine, Air Force, civilian, and international military students, which reduced the available sample population to 109 active duty Army students. The secondary requirement was to only include female officers with two or more combat tours, which was completed during the invitation screening. The population of Army female students with two combat tours was seventy-nine students. The sample of volunteers for interviews consisted of nine female Army students, of whom two were Hispanic, two African American, and five white.

The second sample group for this research was CGSOC faculty members. There were 112 CGSOC total faculty members in support of CGSOC class 2015 but only nine female lieutenant colonel instructors. The researcher interviewed two female faculty members individually to examine perceived incidences of gendered combat stress, female students’ dynamics in the classroom and the impact on their students’ learning.

The third research population sample consisted of behavioral counselors who supported CGSOC students at Fort Leavenworth. The researcher interviewed two counselors to provide background, opinions, and comments with respect to combat stress in reference to CGSOC students.

Interviews and Data Collection

Personal thirty- to sixty-minute semistructured interviews were the primary method of data collection for this qualitative research study. When needed, follow-on questions were added or modified based on previous responses.

Data Analysis

The purpose of using a qualitative research design was to identify themes that emerged throughout the process; it was the most effective method for this exploratory inquiry.19 The patterns in this research only emerged once all the data was collected, grouped, coded, and analyzed.

The interview process allowed the analysis to start on the first interview and continue throughout the entire set of interviews. For each interview, the researcher took interview notes during the interview process, took field notes after each of the interviews, transcribed the voice recordings, continued field notes during the transcription process, and took additional notes on the transcripts for further analysis of each of the interviews. The combination of the three note-taking practices increased the depth of the analysis of each interview.

Analysis and Findings to the Research Questions

Though the demographic profiles of these nine female CGSOC students give insight into their demographic and personal experiences, the interview questions provided more detailed and rich responses to how combat stress affected the female students’ learning experience during their academic year at CGSOC. The comments from the two female CGSOC faculty members and two behavioral health counselors provided additional insight into responses.

Discussion

Ninety-five percent of the students in the CGSOC class of 2015 came into the Army during a time of war after 9/11, and 75 percent went into combat while assigned to their first duty station. This CGSOC class was the first class since 2003 chosen by a Department of Army selection board, resulting in a selection, on average, of the top 55 percent of the officer year group. This selection process of the resident course of CGSOC created a competitive environment within the CGSOC classrooms.

Participant Demographics

The researcher originally anticipated these students would suffer from both academic and combat stress, because this class had cumulatively experienced a great deal of combat. The researcher found that the impact of combat stress on learning depended on the nature of the combat experience. Specifically, combat tours varied both physically and psychologically, with combat experiences ranging from being shot at, seeing wounded or dead bodies, to working behind a computer screen twelve to sixteen hours a day. The female CGSOC interviewees who expressed having the most academic difficulty had been combat wounded or combat wounded with traumatic brain injury. Two of the nine students interviewed had traumatic brain injuries, and one student was injured in combat and received the Purple Heart. These students had the most trouble with memory and attention issues in class. Academic stress varied based on the prior academic background of officers. Three of the female students interviewed were doctors or lawyers and felt the academics were too easy, while two students who went to Officer Candidate School felt less prepared due to their abbreviated education at a local college and an expedited online four-year degree program.

Table 2. Participant Demographics (Table by authors)

A key finding was that faculty (due to curriculum) could trigger combat-related thoughts, memories, and feelings in class. The majority of the students commented that the movie Twelve O’Clock High caused stress in the classroom, especially if the last scene was shown in class.20 Another movie that was concerning to the students was We Were Soldiers, where particular scenes showed soldiers wounded and being loaded on helicopters to be evacuated.21 Many students reacted to those scenes, reexperiencing and reflecting their own personal combat experiences, an emotional result that could affect their learning if not managed well by faculty.

Those interviewed appreciated the competitive achievement of attending the resident course and the richness of their education over the other two options, which were satellite courses (Common Core classes only) or distance learning (two-year course). The students enjoyed the challenge and could visualize the importance of their education for the next ten years of their military career. The visiting general officer lecturers repeatedly emphasized the students’ future leadership responsibilities by comments such as, “the Chief of Staff of the Army for year 2030 is sitting in Eisenhower Auditorium right now.”22 Due to the rigorous selection process of CGSOC students, academic probations were significantly lower in 2015 than the past three years. Just as the students’ individual perspective was important, the instructors were also a key element in the learning process.

Table 2 provides a demographic breakdown of the sample participants. Of the nine CGSOC female students interviewed, four were geographical bachelors, meaning their spouses and/or families were not located with them at Fort Leavenworth. Geographical separations depended on a variety of factors such as a female student married to another military member who was assigned at a different location, or returning to their last duty station and not wanting to move the entire family. Because the separation was a thought-out, practical, and logical decision, the geographical distance did not cause as much academic or personal stress as expected in the research findings.

Five of nine female students interviewed did not have children. This is most likely due to the fact that selection to resident CGSOC happens in the first year of the rank of major; most students are promotable captains, thirty-two years old on average, and in the Army less than ten years with two or more deployments. The students have not had the actual time or opportunity in their career to have children. The researcher did not ask additional questions specifically regarding stressors of children in the protocol, or the type of stress children had on their personal routine. The four students with children were located with their children during their academic year at CGSOC. The assumption that children would add additional stress to students was not evident in the data. While this general discussion provides an overview of the research findings, more detailed analysis will be given by the research questions.

Perceived Effects of Combat Stress on Learning

How do female CGSOC students’ perceive how their multiple combat experiences affect their learning experiences?

Combat stress appeared to affect all soldiers in varying ways, determined by where they were working, their job position in combat, and what they experienced. How the prior combat experiences influenced their learning experience at CGSOC included four themes: (1) the effects of combat experiences, (2) the impact of CGSOC faculty and classroom experiences, (3) the impact of prior education, and (4) gender-related factors. Each of these themes influenced how combat affected learning.

The effects of combat experiences. All of the interviewed female students had two combat tours (eighteen to twenty-four months of combat), but their combat experiences varied from never leaving the forward operating base to having traumatic experiences, seeing multiple dead bodies, or being combat wounded. Every student had some effects from their combat experience. Among the female students, three of the nine students interviewed never left the forward operating base for months at a time and five students worked on battalion-, brigade-, or division-level staff where they spent between twelve and sixteen hours a day in an office behind a computer. Overall, five of the nine students agreed they learned differently after combat due to changes in memory, attention deficit, and inability to retain new knowledge. This finding aligned with prior studies conducted by the National Center for PTSD and other researchers on patterns of behavior after combat. Due to the intent of this research and restrictions by the institutional review board and the Department of Defense, the depth of exploring combat stress was focused specifically toward improving adult learning at CGSS. After the interviews were completed, the researcher assumed that much more trauma (physical, psychological, and gender) occurred than what emerged in the interviews.23 Due to the researcher’s prior combat and leadership experiences, the researcher identified physical behavioral body signs by the students during the interviews of acute duress during certain questions regarding combat experiences. The researcher assumed the students could have more traumatic combat experiences or other female-specific combat experiences but did not explore to remain within the framework of the institutional review board guidelines.

Although all soldiers have the potential to experience varying degrees of stress, the effects of combat varied according to the individual. Prior psychological and combat research concluded that soldiers and civilians who went to a combat zone, whether exposed to combat or not, had some degree of combat-related stress (to include trauma).24 These effects of combat occurred through the process of deployment, family separation, the living experience, and time exposed in a foreign country.25 What these nine female students experienced in combat operations determined the impact of their combat tour on their learning experience, because the female students who were most affected in the classroom environment were combat wounded or personally observed the effects of war. This research demonstrated that students with more traumatic combat experiences in this small sample had the most difficulty academically in CGSOC. In addition, the intersecting ethnicity and socioeconomic demographics factors must be included in the totality of the female students’ combat experience.26 As the researcher collected data from the students on the effects of combat, the references of instructors in the classroom and behavioral counselors were used for triangulation.

Instructors interviewed claimed it was a challenge to know if combat stress was affecting learning. They commented that they did not know how combat had affected their students unless their students actually told them, especially students with no physical signs of combat (e.g., loss of limb, eye, or visible physical scars). Another factor that impacted this research was that some video clips caused reexperiencing combat in the classroom. The CGSOC instructors may not be aware of the prior combat experiences but could observe differences in discomfort during certain students’ reactions to the videos. The researcher identified that some students reexperienced combat events during class, and multiple students commented on the triggering mechanism of visual cues that recalled their combat memories back to the smell of the Iraqi sand or cigarettes. As mentioned earlier, CGSOC instructors should be aware that the 1951 movie Twelve O’Clock High caused intense emotion regarding PTSD, especially if the final scene was used during instruction. The Tailhook case study also caused intense emotions among the female students regarding the prevention of sexual assaults and harassment in the military.27

The CGSOC instructors and behavioral counselors acknowledged that many students who saw horrible things in combat may never share any of their experiences in class, because the students were not emotionally ready to share, the memory was too intense, or were still processing the experience. The CGSOC instructors stated that what happened in combat determines what their students bring to the classroom, provided the classroom is a safe environment. One of the behavioral counselors noted that resiliency affected the impact of combat experiences, because some “students are just mentally tough and able to adapt and cope, and even though they clinically might need behavioral help, their family, and their mindset, and faith is so strong that they are able to adapt to horrific war experiences and still act normal.”28 The counselors commented that students’ combat experiences brought into classroom discussions were positive in the learning process if the classroom dynamics included the students’ respect, and the instructors established a safe learning environment. It was unclear if the female students self-silenced or were only silenced when marginalized, but behavioral health specialists could conclude that the most sharing within cohorts happened in a safe classroom environment established by the instructor and enhanced by the cohort. In this research, the behavioral counselors discussed the effects of stress as individual characteristics, while faculty members assessed the effects due to the classroom environment. Even though personal psychological characteristics influence recovery and ability to adapt, the classroom effects were also an important factor in the adult learning process in the classroom.

The impact of CGSOC faculty and the classroom environment. Many factors affected a student’s physical and psychological ability to deal with combat stress and the ability to learn in the classroom, including the student’s relationship with the instructor, her relationship with the cohort, and the effects of the classroom environment. The most important finding was how deeply the CGSOC faculty and the classroom experience impacted the amount students shared regarding their combat experiences in class discussions. Many students reflected on combat during class in different ways, which included zoning out, feeling anxious or alone, and simply losing track of time. The students who felt academically and personally safe in the classroom with mutual respect from their peers and instructors shared more personal combat experiences with their cohort. The female students who did not have a respectful classroom environment, or who did not have a way to share their experiences with their cohort, were marginalized or not respected and had to deal with their combat experiences in isolation without the benefits described of a positive learning environment.

The impact of prior education. The students with professional degrees prior to combat described lesser effects of combat experience on their learning in CGSOC than others, which was not expected. Having a prior rigorous graduate school experience especially influenced how combat affected learning. Females with professional degrees (legal and medical) experienced lesser amounts of traumatic combat experiences compared to other students based on normal military duty locations and assignments during combat tours.

Gender-related factors in combat. The researcher explored gender-related factors regarding combat experiences. Students explained additional combat stress was caused by being a woman in combat, with the constant threat of sexual harassment, sexual assault, and rape. These findings regarding gender emerged during generalized questions. At no time did the researcher ask follow-up probing questions due to research restrictions, but the topic came up repeatedly with all students. These findings coincided with prior research that women experience significantly higher rates of sexual harassment and assault (within and outside the military) than men.29 The research suggested gender combat stress was more feared and caused more intense emotions during the interviews than when the students were discussing actual combat experiences against an enemy force.

Summary. The research interviews explored if female students appeared to perceive that their combat experiences affected their learning. Those who experienced combat stress were affected, but the variation depended on the individual person. Of the nine female students, five commented they learned differently after combat but not always better. The three students with only a bachelor’s degree also had experienced more combat than the others and identified with attention problems, attention span ability, and inability to learn new concepts. The three students with professional degrees had the least combat experience and their combat experience did not affect their learning at CGSOC.

The key factor to learning for this sample of female students was the learning environment created by faculty skilled in effective adult-learning techniques. An instructor and cohort that facilitated an environment of dignity and respect during classroom dialogue enhanced deep discussion and critical thinking development in the classrooms. In this research, the instructors were identified as key (linchpin) in the development of a positive learning environment, especially for the female students.

Implications of Findings

This research data was complicated, contradictory, and not easy to analyze. Multiple factors impacted the women’s learning, including prior education levels, family situations, ethnicity, effectiveness of instructors, classroom environment, and the military organization. This research only begins to touch on deeper matters due to research restrictions; however, the undiscovered factors that remain could potentially further the understanding of this research topic.

The U.S. Army trains under high academic stress to prepare officers for future combat stress situations, but female officers have additional gender-related stressors that can hinder their military training. This additional gender-related stress occurred in the military performance environment, the classroom, and in combat. The male-dominated Army culture caused women to have additional internalized stress because of having to outperform their male peers to be considered equal. Women serving in the Army have a double dose of stress, including the stress of serving in the military and the stress of being a woman serving in the military. These additional gender stressors can affect the educational and training level outcomes of the military, and other facets of military as an organization. These stressors might be ameliorated somewhat by a greater shift from predominantly white male-oriented (CGSOC faculty is 93 percent male) military training.

Other themes that surfaced in the interviews include that military combat arms branches were more privileged (in terms of prestige and promotion) than combat support and combat service support due to key leadership positions and number of general officers in the Army. Women felt discriminated against due to the disparity among military branches, and some branches excluded women until the past year when the policy changed on female roles in combat and the combat arms.

Summary: Implications for Practice

This research specifically explored female CGSOC students with two or more combat tours, their effects of combat, and their academic learning experience during the 2015 CGSOC class, which the following implies.

The first implication for practice was that what occurs in a combat deployment is more important than how many combat tours a student has; one can’t make easy assumptions about women based solely upon the number of combat tours. Even though all nine female students had two or more combat tours, the effects of combat were dynamically different, which is parallel to current research from the National Center for PTSD.

The second implication for practice reinforced prior research that students who were physically combat wounded will more than likely have some effect on learning. Instructors should know all aspects of their students through prior prescreening. A traumatic brain injury may result from explosions, being hit by mortars, motor vehicle accidents, or being too close to hand grenade blasts. These injuries cause physical damage to the brain, including the prefrontal cortex or the hippocampus, which could also impair their ability to remember and learn new material.30

Notes

  1. Dave Baiocchi, “Measuring Army Deployments to Afghanistan and Iraq” (Santa Monica, CA: RAND Corporation, 2013), accessed 2 March 2018, https://www.rand.org/pubs/research_reports/RR145.html.
  2. “Total Deaths KIA Non-Hostile Pending WIS OIF Casualties,” Department of Defense (DOD), accessed 2 March 2018, http://www.defense.gov/casualty.pdf.
  3. Office of the Press Secretary, “Fact Sheet: The Obama Administration’s Work to Honor Our Military Families and Veterans,” The White House, 10 August 2013, accessed 2 March 2018, http://www.whitehouse.gov/the-press-office/2013/08/10/fact-sheet-obama-administration-s-work-honor-our-military-families-and-v.
  4. Epidemiology Program, Post-Deployment Health Group, Office of Public Health, Veterans Health Administration, Department of Veteran Affairs, “Report on VA Facility Specific Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans Diagnosed with Potential or Provisional PTSD: Cumulative from 1st Qtr FY 2002 through 1st Qtr FY 2014 (October 1, 2001 – December 31, 2013)” (Washington, DC: Department of Veteran Affairs, March 2014), accessed 2 March 2018, http://www.publichealth.va.gov/epidemiology/reports/oefoifond/ptsd/index.asp.
  5. Amy E. Street et al., “Gender Differences among Veterans Deployed in Support of the Wars in Afghanistan and Iraq,” Journal of General Internal Medicine 28, no. S2 (July 2013): S556–62, doi:10.1007/s11606-013-2333-4.
  6. Matthew J. Friedman, “History of PTSD in Veterans: Civil War to DSM-5,” National Center on PTSD, last updated 31 May 2017, accessed 2 March 2018, https://www.ptsd.va.gov/public/PTSD-overview/basics/history-of-ptsd-vets.asp.
  7. “Facts about Women in the Military, 1980-1990,” Women’s Research and Education Institute, accessed 2 March 2018, http://mith.umd.edu/WomensStudies/GovernmentPolitics/Military/factsheet.
  8. Kristin M. Mattocks et al., “Women at War: Understanding How Women Veterans Cope with Combat and Military Sexual Trauma,” Social Science & Medicine 74, no. 4 (2012): 537, accessed 2 March 2018, http://search.proquest.com/docview/921331809?accountid=28992.
  9. “PTSD Overview,” National Center for PTSD, last updated 7 December 2016, accessed 2 March 2018, http://www.ptsd.va.gov/professional/PTSD-overview/index.asp.
  10. Shira Maguen et al., “Gender Differences in the Traumatic Experiences and Mental Health in Active Duty Soldiers Redeployed from Iraq and Afghanistan,” Journal of Psychiatric Research 46 (2012): 311–16, doi:10.1016/j.psychires.2011.11.007.
  11. Sally G. Haskell et al., “The Burden of Illness in the First Year Home: Do Male and Female VA Users Differ in Health Conditions and Healthcare Utilizations,” Womens Health Issues 21, no. 1 (January-February 2011): 92–97, doi:10.1016/j.whi.2010.08.001.
  12. CGSC [Command and General Staff College] Circular 350-1, U.S. Army Command and General Staff College Catalog (Fort Leavenworth, KS: U.S. Army CGSC, January 2016), accessed 2 March 2018, https://usacac.army.mil/sites/default/files/documents/cace/350-1_CGSCCatalog.pdf.
  13. U.S. Army CGSC, “Command Brief” (Fort Leavenworth, KS: 2014).
  14. Ibid.
  15. Ibid.
  16. Ibid.
  17. Kevin P. Shea and Sarah J. Fishback, “Impact of Cumulative Combat Stress on Learning in an Academic Environment,” New Directions for Adult and Continuing Education, no. 136 (Winter 2012): 53–63.
  18. Cheryl Pellerin, “Carter Opens All Military Occupations, Positions to Women,” DOD News, 3 December 2015, accessed 3 March 2018, https://www.defense.gov/News/Article/Article/632536/carter-opens-all-military-occupations-positions-to-women/.
  19. John W. Creswell, Qualitative Inquiry and Research Design: Choosing Among Five Approaches (Thousand Oaks, CA: Sage Publications, 2007).
  20. Twelve O’Clock High (Los Angeles: 20th Century Fox, 1949).
  21. We Were Soldiers (Los Angeles: Icon Productions, 2002).
  22. U.S. Army CGSC, “Command Brief.”
  23. Derrick Silove et al., “The Contribution of Gender-based Violence and Network Trauma to Gender Differences in Post-Traumatic Stress Disorder,” PLoS ONE 12, no. 2 (2017): e0171879, doi:10.1371/journal.pone.0171879.
  24. DOD Task Force on Mental Health, An Achievable Vision: Report of the Department of Defense Task Force on Mental Health (Falls Church, VA: Defense Health Board, Department of Veterans Affairs, June 2007), accessed 5 March 2018, https://ia802500.us.archive.org/31/items/AnAchievableVisionReportOfTheDepartmentOfDefenseTaskForceOnMental/MHTF-Report-Final.pdf.
  25. Terri Tanielian and Lisa H. Jaycox, eds., “Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery” (Santa Monica, CA: RAND Corporation, 2008), accessed 5 March 2018, http://www.rand.org/pubs/monographs/MG720/.
  26. Maguen et al., “Gender Differences in the Traumatic Experiences and Mental Health.”
  27. Joslyn Ogden, Tailhook ‘91 and the U.S. Navy (Durham, NC: The Kenan Institute for Ethics at Duke University, n.d.), accessed 5 March 2018, https://web.duke.edu/kenanethics/CaseStudies/Tailhook&USNavy.pdf.
  28. Original transcripts from student interviews with Paul Berg, 2015.
  29. Andrew R. Morral, Kristie L. Gore, and Terry L. Schell, eds., “Sexual Assault and Sexual Harassment in the Military: Volume 1. Design of the 2014 RAND Military Workplace Study” (Santa Monica: CA RAND Corporation, 2014), accessed 5 March 2018, https://www.rand.org/content/dam/rand/pubs/research_reports/RR800/RR870z1/RAND_RR870z1.pdf.
  30. DOD Task Force on Mental Health, An Achievable Vision.

Col. Paul Berg, PhD, U.S. Army, is the division chief of Academic Affairs at Army University at Fort Leavenworth, Kansas. Berg received his PhD from Kansas State University in adult and continuing education. He is a former battalion commander with four combat tours.

Jessica Rousseau, MS, received her BS in English and her MS in psychology with an emphasis in mental health counseling. She has worked over the years counseling military service members and their families. Rousseau is currently a licensed professional counselor with the state of Kansas and is working as an American Psychological Association editor.

April 2018